Cortisol (cortisol; not to be confused with cortisone (cortisone), the inactivated form of cortisol) is a hormone synthesized in the zona fasciculata of the adrenal cortex and belongs to the glucocorticoid group. It is regulated by higher-level hormones such as ACTH (adrenocorticotropic hormone).It has its function mainly effects on carbohydrate balance (promoting gluconeogenesis in the liver), lipid metabolism (promoting the lipolytic effect of adrenaline and noradrenaline) and protein turnover (catabolic). It has antiphlogistic (anti-inflammatory) and immunosuppressive effects.
The procedure
Material needed
- Blood serum
Preparation of the patient
- Three blood draws: 8 a.m., 12 p.m., 6 p.m.
Confounding factors
Normal values – basal value
| Age | Normal values in μg/dl |
| 5th day of life | 0,6-20 |
| 2-12 months of age | 2,4-23 |
| 2-15 years of age | 2,5-23 |
| 16-18 years of age | 2,4-29 |
| Adult | 4-22 |
Normal values – daily profile
| Time | Normal values in μg/dl |
| 12 o’clock | Decrease compared to morning value (8:00 a.m.) |
| 6 p.m. | 8 a.m. value halved |
| 24 o’clock | 0-5 μg/dl |
Indications
- Suspected hypercortisolism (hypercortisolism; excess of cortisol).
- In severe general diseases
Interpretation
Interpretation of elevated values, i.e., cancellation of diurnal rhythm.
- Cushing’s disease – clinical picture caused by an excess of glucocorticoids (hypercortisolimus) (clarification required whether primary or secondary; see ACTH for details).
- Pseudo-Cushing’s – occurs mainly in gravidity (pregnancy) and alcoholism.
False-high values can occur in
- Obesity
- Anorexia nervosa
- Acute psychoses
- Acute diseases
- Infections
- Estrogen therapy/contraceptives (an increase in corticosteroid-binding globulin – e.g., estrogen therapy – can lead to an increase in cortisol)
- Stress
- Burns
Interpretation of lowered values
- Addison’s disease (primary adrenocortical insufficiency).
- Secondary hypocortisolism (secondary adrenal insufficiency).
- Adrenogenital syndrome (AGS) with 21-hydroxylase deficiency, or 20,2-desmolase deficiency or 11-β-hydroxylase deficiency – autosomal recessive inherited metabolic disorder characterized by disorders of hormone synthesis in the adrenal cortex. These disorders lead to a deficiency of aldosterone and cortisol.
- Cortisone therapy
Notes
- If test results are unclear, perform a dexamethasone short test